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Testing with Antineutrophil Cytoplasmic Antibody To Diagnose Wegener Granulomatosis
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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TO THE EDITOR:
Rao and colleagues [1] provide an important critical analysis of the role of antineutrophil cytoplasmic antibody (c-ANCA) testing in the diagnosis of Wegener granulomatosis. They correctly emphasize the dangers of a positive test result in the setting of low pretest probability of this disorder. Their discussion includes a comparison of data from the National Institutes of Health (NIH) cohort [2] and that of Cohen Tervaert and colleagues [3]. This comparison requires clarification. It is stated that, in the NIH series, c-ANCA titers temporally correlated with changes in disease activity in only 24% of patients. This is not entirely correct. The 24% refers to the frequency with which an increase in c-ANCA titer preceded a relapse in patients who were previously in remission or who had mild, smoldering disease. This observation emphasizes that, in our experience, an increase in c-ANCA titer in relatively well and stable patients is often not followed by clinical exacerbation. Thus, we found changing titers in this subset not to be a reliable prognostic marker. When we compared c-ANCA titer changes with disease activity, we found that 64% of patients had a concurrent change in c-ANCA titers and improvement or worsening of disease. Like Rao and colleagues, we urge caution for those who would substitute changes in c-ANCA titer for careful clinical evaluation.
Gary S. Hoffman, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
